Part IV in this series discusses expanding HIM’s visibility and enhancing organizational processes via authorization denial management.
In my prior article, I discussed the value of payer policy management, and mentioned that “no authorization” denials represent 10-15 percent of all denials. This focused denial category presents another opportunity for health information management (HIM) professionals. HIM can monitor such denials in a process improvement role.
Many organizations perceive denials management as a back-of-the-house process, but all authorizations are a front-of-the house responsibility. For physician practices, denials for lack of authorization represent 80 percent of the total, so working with your hospital-employed providers to avoid such pitfalls by capturing the authorizations required at the time of scheduling the service will mean “cha–ching” – and you know that’s what your CFO wants to hear.
So, what do we need to do?
Sitting in access at the hospital should be someone with some clinical expertise, such as a coding professional, who knows that this is a normal chain of events. In the physician office, the authorization specialist can quiz the physician to ensure that authorizations are captured for the commonly anticipated services.
Some inpatient procedures require authorizations as well. Since eligibility may change during a given stay, the workflow for scheduling should include re-checking eligibility throughout the stay, and also obtaining authorizations for any new procedures planned.
According to an Healthcare Financial Management Association (HFMA) article, up to 65 percent of denied claims are never appealed. Focusing attention on denials for lack of authorization and reducing those denials through process improvement will reduce the labor costs to research and appeal denials, as well as increase revenues – and that’s what we’re going for.
Good luck!
Programming Note: Listen to Rose Dunn report this story live today during Talk Ten Tuesdays, 10 Eastern.
EDITOR’S NOTE: On the morning of Jan. 22, major American news outlets were reporting the story of a huge artificial intelligence (AI) technology partnership. The
New personnel changes to the long-running and popular Talk Ten Tuesdays weekly Internet broadcast produced by ICD10monitor have been formally announced. New voices and faces
Please log in to your account to comment on this article.
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
